
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC280c-6]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                    CHAPTER 6A--PUBLIC HEALTH SERVICE
 
                SUBCHAPTER II--GENERAL POWERS AND DUTIES
 
                Part K--Health Care Services in the Home
 
   subpart iii--grants for home visiting services for at-risk families
 
Sec. 280c-6. Projects to improve maternal, infant, and child 
        health
        

(a) In general

                    (1) Establishment of program

        The Secretary, acting through the Administrator of the Health 
    Resources and Services Administration, shall make grants to eligible 
    entities to pay the Federal share of the cost of providing the 
    services specified in subsection (b) of this section to families in 
    which a member is--
            (A) a pregnant woman at risk of delivering an infant with a 
        health or developmental complication; or
            (B) a child less than 3 years of age--
                (i) who is experiencing or is at risk of a health or 
            developmental complication, or of child abuse or neglect; or
                (ii) who has been prenatally exposed to maternal 
            substance abuse.

     (2) Minimum period of awards; administrative consultations

        (A) The Secretary shall award grants under paragraph (1) for 
    periods of at least three years.
        (B) The Administrator of the Administration for Children, Youth, 
    and Families and the Director of the National Commission to Prevent 
    Infant Mortality shall be consulted regarding the promulgation of 
    program guidelines and funding priorities under this section.

           (3) Requirement of status as medicaid provider

        (A) Subject to subparagraph (B), the Secretary may make a grant 
    under paragraph (1) only if, in the case of any service under such 
    paragraph that is covered in the State plan approved under title XIX 
    of the Social Security Act [42 U.S.C. 1396 et seq.] for the State 
    involved--
            (i) the entity involved will provide the service directly, 
        and the entity has entered into a participation agreement under 
        the State plan and is qualified to receive payments under such 
        plan; or
            (ii) the entity will enter into an agreement with an 
        organization under which the organization will provide the 
        service, and the organization has entered into such a 
        participation agreement and is qualified to receive such 
        payments.

        (B)(i) In the case of an organization making an agreement under 
    subparagraph (A)(ii) regarding the provision of services under 
    paragraph (1), the requirement established in such subparagraph 
    regarding a participation agreement shall be waived by the Secretary 
    if the organization does not, in providing health or mental health 
    services, impose a charge or accept reimbursement available from any 
    third-party payor, including reimbursement under any insurance 
    policy or under any Federal or State health benefits program.
        (ii) A determination by the Secretary of whether an organization 
    referred to in clause (i) meets the criteria for a waiver under such 
    clause shall be made without regard to whether the organization 
    accepts voluntary donations regarding the provision of services to 
    the public.

(b) Home visiting services for eligible families

    With respect to an eligible family, each of the following services 
shall, directly or through arrangement with other public or nonprofit 
private entities, be available (as applicable to the family member 
involved) in each project operated with a grant under subsection (a) of 
this section:
        (1) Prenatal and postnatal health care.
        (2) Primary health care for the children, including 
    developmental assessments.
        (3) Education for the parents concerning infant care and child 
    development, including the development and utilization of parent and 
    teacher resource networks and other family resource and support 
    networks where such networks are available.
        (4) Upon the request of a parent, providing the education 
    described in paragraph (3) to other individuals who have 
    responsibility for caring for the children.
        (5) Education for the parents concerning behaviors that 
    adversely affect health.
        (6) Assistance in obtaining necessary health, mental health, 
    developmental, social, housing, and nutrition services and other 
    assistance, including services and other assistance under maternal 
    and child health programs; the special supplemental nutrition 
    program for women, infants, and children; section 1786 of this 
    title; title V of the Social Security Act [42 U.S.C. 701 et seq.]; 
    title XIX of such Act [42 U.S.C. 1396 et seq.] (including the 
    program for early and periodic screening, diagnostic, and treatment 
    services described in section 1905(r) of such Act [42 U.S.C. 
    1396d(r)]); titles IV and XIX of the Social Security Act [42 U.S.C. 
    601 et seq., 1396 et seq.]; housing programs; other food assistance 
    programs; and appropriate alcohol and drug dependency treatment 
    programs, according to need.

(c) Considerations in making grants

    In awarding grants under subsection (a) of this section, the 
Secretary shall take into consideration--
        (1) the ability of the entity involved to provide, either 
    directly or through linkages, a broad range of preventive and 
    primary health care services and related social, family support, and 
    developmental services;
        (2) different combinations of professional and lay home visitors 
    utilized within programs that are reflective of the identified 
    service needs and characteristics of target populations;
        (3) the extent to which the population to be targeted has 
    limited access to health care, and related social, family support, 
    and developmental services; and
        (4) whether such grants are equitably distributed among urban 
    and rural settings and whether entities serving Native American 
    communities are represented among the grantees.

(d) Federal share

    With respect to the costs of carrying out a project under subsection 
(a) of this section, a grant under such subsection for the project may 
not exceed 90 percent of such costs. To be eligible to receive such a 
grant, an applicant must provide assurances that the applicant will 
obtain at least 10 percent of such costs from non-Federal funds (and 
such contributions to such costs may be in cash or in-kind, including 
facilities and personnel).

(e) Rule of construction regarding at-risk births

    For purposes of subsection (a)(1) of this section, a pregnant woman 
shall be considered to be at risk of delivering an infant with a health 
or developmental complication if during the pregnancy the woman--
        (1) lacks appropriate access to, or information concerning, 
    early and routine prenatal care;
        (2) lacks the transportation necessary to gain access to the 
    services described in subsection (b) of this section;
        (3) lacks appropriate child care assistance, which results in 
    impeding the ability of such woman to utilize health and related 
    social services;
        (4) is fearful of accessing substance abuse services or child 
    and family support services; or
        (5) is a minor with a low income.

(f) Delivery of services and case management

                      (1) Case management model

        Home visiting services provided under this section shall be 
    delivered according to a case management model, and a registered 
    nurse, licensed social worker, or other licensed health care 
    professional with experience and expertise in providing health and 
    related social services in home and community settings shall be 
    assigned as the case manager for individual cases under such model.

                          (2) Case manager

        A case manager assigned under paragraph (1) shall have primary 
    responsibility for coordinating and overseeing the development of a 
    plan for each family that is to receive home visiting services under 
    this section, and for coordinating the delivery of such services 
    provided through appropriate personnel.

                      (3) Appropriate personnel

        In determining which personnel shall be utilized in the delivery 
    of services, the case manager shall consider--
            (A) the stated objective of the project to be operated with 
        the grant, as determined after considering identified gaps in 
        the current service delivery system; and
            (B) the nature of the needs of the family to be served, as 
        determined at the initial assessment of the family that is 
        conducted by the case manager, and through follow-up contacts by 
        other providers of home visiting services.

                       (4) Family service plan

        A case manager, in consultation with a team established in 
    accordance with paragraph (5) for the family involved, shall develop 
    a plan for the family following the initial visit to the home of the 
    family. Such plan shall reflect--
            (A) an assessment of the health and related social service 
        needs of the family;
            (B) a structured plan for the delivery of home visiting 
        services to meet the identified needs of the family;
            (C) the frequency with which such services are to be 
        provided to the family;
            (D) ongoing revisions made as the needs of family members 
        change; and
            (E) the continuing voluntary participation of the family in 
        the plan.

                   (5) Home visiting services team

        The team to be consulted under paragraph (4) on behalf of a 
    family shall include, as appropriate, other nursing professionals, 
    physician assistants, social workers, child welfare professionals, 
    infant and early childhood specialists, nutritionists, and 
    laypersons trained as home visitors. The case manager shall ensure 
    that the plan is coordinated with those physician services that may 
    be required by the mother or child.

(g) Outreach

    Each grantee under subsection (a) of this section shall provide 
outreach and casefinding services to inform eligible families of the 
availability of home visiting services from the project.

(h) Confidentiality

    In accordance with applicable State law, an entity receiving a grant 
under subsection (a) of this section shall maintain confidentiality with 
respect to services provided to families under this section.

(i) Certain assurances

    The Secretary may award a grant under subsection (a) of this section 
only if the entity involved provides assurances satisfactory to the 
Secretary that--
        (1) the entity will provide home visiting services with 
    reasonable frequency--
            (A) to families with pregnant women, as early in the 
        pregnancy as is practicable, and until the infant reaches at 
        least 2 years of age; and
            (B) to other eligible families, for at least 2 years; and

        (2) the entity will coordinate with public health and related 
    social service agencies to prevent duplication of effort and improve 
    the delivery of comprehensive health and related social services.

(j) Submission to Secretary of certain information

    The Secretary may award a grant under subsection (a) of this section 
only if the entity involved submits to the Secretary--
        (1) a description of the population to be targeted for home 
    visiting services and methods of outreach and casefinding for 
    identifying eligible families, including the use of lay home 
    visitors where appropriate;
        (2) a description of the types and qualifications of home 
    visitors used by the entity and the process by which the entity will 
    provide continuing training and sufficient support to the home 
    visitors; and
        (3) such other information as the Secretary determines to be 
    appropriate.

(k) Limitation regarding administrative expenses

    Not more than 10 percent of a grant under subsection (a) of this 
section may be expended for administrative expenses with respect to the 
grant. The costs of training individuals to serve in the project 
involved are not subject to the preceding sentence.

(l) Restrictions on use of grant

    To be eligible to receive a grant under this section, an entity must 
agree that the grant will not be expended--
        (1) to provide inpatient hospital services;
        (2) to make cash payments to intended recipients of services;
        (3) to purchase or improve land, purchase, construct, or 
    permanently improve (other than minor remodeling) any building or 
    other facility, or purchase major medical equipment;
        (4) to satisfy any requirement for the expenditure of non-
    Federal funds as a condition for the receipt of Federal funds; or
        (5) to provide financial assistance to any entity other than a 
    public or nonprofit private entity.

(m) Reports to Secretary

    To be eligible to receive a grant under this section, an entity must 
agree to submit an annual report on the services provided under this 
section to the Secretary in such manner and containing such information 
as the Secretary by regulation requires. At a minimum, the entity shall 
report information concerning eligible families, including--
        (1) the characteristics of the families and children receiving 
    services under this section;
        (2) the usage, nature, and location of the provider, of 
    preventive health services, including prenatal, primary infant, and 
    child health care;
        (3) the incidence of low birthweight and premature infants;
        (4) the length of hospital stays for pre- and post-partum women 
    and their children;
        (5) the incidence of substantiated child abuse and neglect for 
    all children within participating families;
        (6) the number of emergency room visits for routine health care;
        (7) the source of payment for health care services and the 
    extent to which the utilization of health care services, other than 
    routine screening and medical care, available to the individuals 
    under the program established under title XIX of the Social Security 
    Act [42 U.S.C. 1396 et seq.], and under other Federal, State, and 
    local programs, is reduced;
        (8) the number and type of referrals made for health and related 
    social services, including alcohol and drug treatment services, and 
    the utilization of such services provided by the grantee; and
        (9) the incidence of developmental disabilities.

(n) Requirement of application

    The Secretary may make a grant under subsection (a) of this section 
only if--
        (1) an application for the grant is submitted to the Secretary;
        (2) the application contains the agreements and assurances 
    required in this section, and the information required in subsection 
    (j) of this section;
        (3) the application contains evidence that the preparation of 
    the application has been coordinated with the State agencies 
    responsible for maternal and child health and child welfare, and 
    coordinated with services provided under part H \1\ of the 
    Individuals with Disabilities Education Act; and
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    \1\ See References in Text note below.
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        (4) the application is in such form, is made in such manner, and 
    contains such agreements, assurances, and information as the 
    Secretary determines to be necessary to carry out this section.

(o) Peer review

                           (1) Requirement

        In making determinations for awarding grants under subsection 
    (a) of this section, the Secretary shall rely on the recommendations 
    of the peer review panel established under paragraph (2).

                           (2) Composition

        The Secretary shall establish a review panel to make 
    recommendations under paragraph (1) that shall be composed of--
            (A) national experts in the fields of maternal and child 
        health, child abuse and neglect, and the provision of community-
        based primary health services; and
            (B) representatives of relevant Federal agencies, including 
        the Health Resources and Services Administration, the Substance 
        Abuse and Mental Health Services Administration, the 
        Administration for Children, Youth, and Families, the U.S. 
        Advisory Board on Child Abuse and Neglect, and the National 
        Commission to Prevent Infant Mortality.

(p) Evaluations

                           (1) In general

        The Secretary shall, directly or through contracts with public 
    or private entities--
            (A) conduct evaluations to determine the effectiveness of 
        projects under subsection (a) of this section in reducing the 
        incidence of children born with health or developmental 
        complications, the incidence among children less than 3 years of 
        age of such complications, and the incidence of child abuse and 
        neglect; and
            (B) not less than once during each 3-year period, prepare 
        and submit to the appropriate committees of Congress a report 
        concerning the results of such evaluations.

                            (2) Contents

        The evaluations conducted under paragraph (1) shall--
            (A) include a summary of the data contained in the annual 
        reports submitted under subsection (m) of this section;
            (B) assess the relative effectiveness of projects under 
        subsection (a) of this section in urban and rural areas, and 
        among programs utilizing differing combinations of professionals 
        and trained home visitors recruited from the community to meet 
        the needs of defined target service populations; and
            (C) make further recommendations necessary or desirable to 
        increase the effectiveness of such projects.

(q) Definitions

    For purposes of this section:
        (1) The term ``eligible entity'' includes public and nonprofit 
    private entities that provide health or related social services, 
    including community-based organizations, visiting nurse 
    organizations, hospitals, local health departments, community health 
    centers, Native Hawaiian health centers, nurse managed clinics, 
    family service agencies, child welfare agencies, developmental 
    service providers, family resource and support programs, and 
    resource mothers projects.
        (2) The term ``eligible family'' means a family described in 
    subsection (a) of this section.
        (3) The term ``health or developmental complication'', with 
    respect to a child, means--
            (A) being born in an unhealthy or potentially unhealthy 
        condition, including premature birth, low birthweight, and 
        prenatal exposure to maternal substance abuse;
            (B) a condition arising from a condition described in 
        subparagraph (A);
            (C) a physical disability or delay; and
            (D) a developmental disability or delay.

        (4) The term ``home visiting services'' means the services 
    specified in subsection (b) of this section, provided at the 
    residence of the eligible family involved or provided pursuant to 
    arrangements made for the family (including arrangements for 
    services in community settings).
        (5) The term ``home visitors'' means providers of home visiting 
    services.

(r) Authorization of appropriations

    For the purpose of carrying out this section, there is authorized to 
be appropriated $30,000,000 for each of the fiscal years 1993 and 1994.

(July 1, 1944, ch. 373, title III, Sec. 399, as added Pub. L. 102-321, 
title V, Sec. 502(2), July 10, 1992, 106 Stat. 427; amended Pub. L. 103-
448, title II, Sec. 204(w)(2)(D), Nov. 2, 1994, 108 Stat. 4746.)

                       References in Text

    The Social Security Act, referred to in subsecs. (a)(3)(A), (b)(6), 
and (m)(7), is act Aug. 14, 1935, ch. 531, 49 Stat. 620, as amended. 
Titles IV, V, and XIX of the Act are classified generally to subchapters 
IV (Sec. 601 et seq.), V (Sec. 701 et seq.), and XIX (Sec. 1396 et 
seq.), respectively, of chapter 7 of this title. For complete 
classification of this Act to the Code, see section 1305 of this title 
and Tables.
    The Individuals with Disabilities Education Act, referred to in 
subsec. (n)(3), is title VI of Pub. L. 91-230, Apr. 13, 1970, 84 Stat. 
175, as amended. Part H of the Act was classified generally to 
subchapter VIII (Sec. 1471 et seq.) of chapter 33 of Title 20, 
Education, prior to repeal by Pub. L. 105-17, title II, Sec. 203(b), 
June 4, 1997, 111 Stat. 157, effective July 1, 1998. For complete 
classification of this Act to the Code, see section 1400 of Title 20 and 
Tables.


                            Prior Provisions

    A prior section 399 of act July 1, 1944, was renumbered section 398A 
by section 502(1) of Pub. L. 102-321 and is classified to section 280c-4 
of this title.
    Another prior section 399 of act July 1, 1944, ch. 373, title III, 
formerly Sec. 399b, as added Oct. 22, 1965, Pub. L. 89-291, Sec. 2, 79 
Stat. 1066; renumbered Sec. 399a and amended Mar. 13, 1970, Pub. L. 91-
212, Sec. 10(c)(3), (d)(2)(A), 84 Stat. 67; renumbered Sec. 399, July 
23, 1974, Pub. L. 93-353, title II, Sec. 204, 88 Stat. 373; Oct. 17, 
1979, Pub. L. 96-88, title V, Sec. 509(b), 93 Stat. 695, which related 
to the maintenance of records by recipients of grants and audits thereof 
by the Secretary of Health and Human Services and the Comptroller 
General of the United States, was classified to section 280b-11 of this 
title, prior to repeal by Pub. L. 99-158, Sec. 3(b), Nov. 20, 1985, 99 
Stat. 879.


                               Amendments

    1994--Subsec. (b)(6). Pub. L. 103-448 substituted ``special 
supplemental nutrition program'' for ``special supplemental food 
program''.


                    Effective Date of 1994 Amendment

    Amendment by Pub. L. 103-448 effective Oct. 1, 1994, see section 401 
of Pub. L. 103-448, set out as a note under section 1755 of this title.


                             Effective Date

    Section effective July 10, 1992, with programs making awards 
providing financial assistance in fiscal year 1993 and subsequent years 
effective for awards made on or after Oct. 1, 1992, see section 801(b), 
(d)(1) of Pub. L. 102-321, set out as an Effective Date of 1992 
Amendment note under section 236 of this title.


  Reference to Community, Migrant, Public Housing, or Homeless Health 
              Center Considered Reference to Health Center

    Reference to community health center, migrant health center, public 
housing health center, or homeless health center considered reference to 
health center, see section 4(c) of Pub. L. 104-299, set out as a note 
under section 254b of this title.


                                 Purpose

    Section 501 of title V of Pub. L. 102-321 provided that: ``The 
purpose of this title [enacting this section] is--
        ``(1) to increase the use of, and to provide information on the 
    availability of early, continuous and comprehensive prenatal care;
        ``(2) to reduce the incidence of infant mortality and of infants 
    born prematurely, with low birthweight, or with other impairments 
    including those associated with maternal substance abuse;
        ``(3) for pregnant women and mothers of children below the age 
    of 3 whose children have experienced or are at risk of experiencing 
    a health or developmental complication, to provide assistance in 
    obtaining health and related social services necessary to meet the 
    special needs of the women and their children;
        ``(4) to assist, when requested, women who are pregnant and at-
    risk for poor birth outcomes, or who have young children and are 
    abusing alcohol or other drugs, in obtaining appropriate treatment; 
    and
        ``(5) to reduce the incidence of child abuse and neglect.''
